JMIR Publications

ABSTRACT

Background:

Given the high prevalence of e-cigarette use across the globe and potential health concerns, it is important to conduct e-cigarette actual use behavior assessments to better understand how these products are being consumed in real-world conditions. However, there is a lack of noninvasive, non-interventional, and convenient instruments for the real-time and real-world use behavior monitoring during e-cigarette usage. Novel technology-based systems that do not primarily rely on self-report or intrusive laboratory measurements to monitor e-cigarette use behaviors are highly desired.

Objective:

The aim of this study is to investigate real-world actual use behaviors of e-cigarette with data collected from a novel puff recording electronic nicotine delivery system (PR-ENDS).

Methods:

In real-world conditions, 61 UK e-cigarette users enrolled during a product trial were instructed to use PR-ENDS as the primary source of nicotine with their selected e-liquids for at least three weeks (21 days). A baseline survey was conducted to collect information about participants’ demographics and nicotine use history (cigarette and ENDS). The puff data (i.e., puff number, puff duration for each puff, device power, e-liquid nicotine concentrations, etc.) was directly recorded by PR-ENDS and uploaded to the cloud. The nicotine emission and nicotine consumption were estimated based on recorded puff data.

Results:

Middle-aged adults with a nicotine history represented the major user profile during PR-ENDS trial. A wide range of device power and e-liquid nicotine concentration was applied and their combinations during actual use were found to be rather complex. Various puff parameters (i.e., puff duration, puff number, nicotine emission, etc.) were assessed with contributing factors from device, e-liquid, and user nicotine history in different effect sizes. The real-time observation revealed significant intra- and inter-individual variabilities in PR-ENDS use behaviors. A use pattern of quick adaptation followed by consistent product use was recognized for at least 3 weeks during actual use.

Conclusions:

The actual use behavior assessment of PR-ENDS was conducted as a proof-of-concept application. The complex interactions of product attributes and significant intra- and inter-individual variabilities in e-cigarette use behaviors provided new insights of compensatory behaviour, which can inspire future studies in the field of nicotine addiction and abuse liability behavior assessment.